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HISTORICAL NOTES
ABSTRACT
The authors present a historical review of the contribution of Professor Abraham Akerman to Brazilian neurology, including the famous sign known as “the Alajouanine-Akerman unstable ataxic hand”.
Key words: neurology, history,pseudoathetosis, Brazil.
RESUMO
Os autores apresentam uma revisão histórica sobre a contribuição do Professor Abraham Akerman para a Neurologia brasileira, incluindo o famoso sinal “Mão instável atáxica de Alajouanine-Akerman”.
Palavras-Chave: neurologia, história, pseudo-atetose, Brasil.
Professor Abraham Akerman
Professor Abraham Akerman
Hélio Afonso Ghizoni Teive1, Francis Paciornik Zorzetto1, Adriana Moro1, Renato Puppi Munhoz1,
Péricles Andrade Maranhão Filho2, Edison Matos Novak1
1Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba PR, Brazil;
2Neurology Department, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.
Correspondence: Hélio Afonso Ghizoni Teive; Rua General Carneiro 1103 / 102; 80060-150 Curitiba PR - Brasil; E-mail: hagteive@mps.com.br
Conlict of interest: There is no conflict of interest to declare.
Received 9 February 2013; Received in final form 23 April 2013; Accepted 30 April 2013.
From the archives of the Professor Abraham Akerman library.
Fig 1. Professor Théophile Alajouanine (seated in the center) and his disciples, including Professor Abraham Akerman (arrow).
Brazilian neurology was greatly inluenced by the French school of neurology. In the nineteenth century, the Salpêtrière Hospital in Paris, France, was considered the mecca of neurol-ogy, and Professor Jean-Martin Charcot was considered the father of neurology1-4. he irst professors of neurology in Brazil
were Dr. Antonio Austregésilo, of the National College of Rio de Janeiro (1912), a pioneer in neurology and movement disorder studies, and Dr. Enjolras Vampré, in São Paulo (1925), who coor-dinated the neurology and psychiatry clinic at the São Paulo Faculty of Medicine and Surgery, later to become the Faculty of Medicine at the Universidade de São Paulo1-5. Both Austregésilo
and Vampré trained in diferent neurology services in Paris, France, primarily in those coordinated by Charcot’s disciples, such as Pierre Marie, Babinski, and Dejerine1-3,5. Between 1948
and 1960, Professor héophile Alajouanine occupied the chair of diseases of the nervous system at the Paris Faculty of Medicine6.
His disciples, who came from all around the world, included Dr. Abraham Akerman, who was from Rio de Janeiro, Brazil.
ABRAHAM AKERMAN
Abraham Akerman, who was of Jewish origin, was born to a family from Eastern Europe in 1908 and came to Brazil as a child, where he lived in the city of Rio de Janeiro7–9. In 1924,
Akerman traveled to Paris, France, and studied in the Faculty of Sciences at the University of Paris. In 1926, he enrolled in
the Faculty of Medicine at the same university, going on to graduate in 19307-9. After obtaining his PhD from the University
of Paris with a thesis on brucellosis in 1933, Akerman went on to train with various leading French neurologists, such as Guillain, Crouzon, Nageotte, and héophile Alajouanine7-9.
His period with Professor Alajouanine was the most produc-tive, and Akerman considered him to be his true mentor7-9.
Fig 1 shows Professor Alajouanine together with his disciples,
Teive et al. Prof Abraham Akerman 641 astereognostic multiple sclerosis attack”)10. h e authors
described a case report of a 39-year-old patient with a previ-ous diagnosis of multiple sclerosis who presented with signs and symptoms of sensory ataxia of the right hand along with astereognosis, impaired deep sensation, and pseudoatheto-sis of the right hand (Fig 2). h ey discussed the dif erential diagnosis with thalamic hand and reported that there was a marked improvement in pseudoathetosis after two weeks10.
THE PROFESSOR ABRAHAM AKERMAN LIBRARY
In December 2012, the Professor Abraham Akerman Library was inaugurated in Curitiba, Paraná, in the Neurol-ogy Service, Hospital de Clínicas, Federal University of Par-aná. h e library is a cultural collection containing 1800 books on neurological sciences, many of them being classics of French neurology, including a large number of books from the Charcot school at Salpêtrière and books by leading neurolo-gists from around the world. h e library was made possible, thanks to a generous donation by Zeldi Akerman, Professor Akerman’s daughter, through the Paciornik family in Curitiba.
CONCLUSION
Professor Abraham Akerman, an eminent twentieth- century Brazilian neurologist, made an important contribu-tion to the progress of neurological sciences in Brazil, notably with the description of a well-known neurological sign, the Alajouanine-Akerman unstable ataxic hand.
among them Professor Akerman, and the complete nursing team in the neurology service, Salpêtrière Hospital.
In 1933, Akerman returned to Rio de Janeiro and worked with professors Antônio Austregésilo, José Ribeiro Portugal, Paulo Niemayer, and, later, Deolindo Couto7-9. Between 1938
and 1940, he trained in the Department of Neuropathology at the Universidade de São Paulo. In 1956, he became a coordina-tor of the 34th Ward of the Santa Casa de Misericórdia Hospital
in Rio de Janeiro, where he established a School of Neurology and acquired various disciples, among them Professor Nunjo Finkel7,8. Akerman was a permanent member of the Rio de
Janeiro Society of Neurology, Psychiatry, and Forensic Medi-cine, and in 1952, he was made an honorary member of the French Society of Neurology (on the recommendation of pro-fessors h éophile Alajouanine and Jean Lhermitte). In 1970, he was a visiting professor at the Mount Sinai School of Medicine, University of New York. Akerman had a private practice and was one of the most highly regarded and successful neurolo-gists of his time. He died in 1985 at the age of 777-9.
AKERMAN’S SCIENTIFIC CONTRIBUTION
Akerman’s scientii c contribution to neurology in Rio de Janeiro and in Brazil can be judged from the School of Neurol-ogy that he established, which had various disciples, and from his involvement with foreign neurology services, initially in Paris, through his great friendship with Professor h éophile Alajouanine, then in London, through his close relationship with Professor McDonald Critchley, later in Germany and i nally in the USA (New York) in the 1970s7-9. Akerman was a
host in Rio de Janeiro to many luminaries of international neu-rology, particularly professors Jean Lhermitte from France and McDonald Critchley7-9. Akerman’s main contribution to
semiol-ogy was the description he and his famous mentor Alajouanine published of the Alajouanine–Akerman unstable ataxic hand10.
THE ALAJOUANINE–AKERMAN UNSTABLE
ATAXIC HAND
h e Alajouanine-Akerman unstable ataxic hand was described in 1931 in the journal Revue Neurologique in a very important scientii c paper titled “Attitude de la main dans une poussée monobrachiale astéréognosique de la sclé-rose en plaques” (“Attitude of the hand in a monobrachial
From the archives of the Professor Abraham Akerman library.
Fig 2. Alajouanine–Akerman unstable ataxic (right) hand.
1. Teive HAG, Almeida SM, Arruda WO, Sá DS, Werneck LC. Charcot and Brazil. Arq Neuropsiquiatr 2001;59:295-299.
2. Gomes MM. Vultos da história da Neurologia do Rio de Janeiro. In: Reimão R (Ed). História da Neurologia no Brasil. São Paulo: Lemos Editorial; 1999:43-51.
3. Gomes MM. Marcos Históricos da Neurologia. Rio de Janeiro: Editora Científi ca Nacional; 1997:163-165.
References
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5. Teive HAG, Sá D, Silveira Neto O, Silveira OA, Werneck LC. Professor Antonio Austregésilo. O pioneiro da neurologia e do estudo dos distúr-bios do movimento no Brasil. Arq Neuropsiquiatr 1999;57:898-902.
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7. Academia de Medicina do Rio de Janeiro. Abraham Akerman. Avail-able at http://www.amrjorg.br/bio_cad 91_p. pdf
8. Maranhão Filho PA. A mão instável atáxica de Alajouanine-Aker-man (1931). In: Maranhão Filho PA (Ed). Autores Brasileiros. Mais de um século de sinais, síndromes e outras contribuições neu-rológicas e neurocirúrgicas (1878–1998). São Paulo: Editora Omni-farma; 2008:17-19.
9. Levy G. Mão instável atáxica de Alajouanine-Akerman. Res-gate de um sinal neurológico. Arq Neuropsiquiatr 1999; 57:326-328.
